Tracking target position variability using intraprostatic fiducial markers and electronic portal imaging in prostate cancer radiotherapy

Muñoz, Fernándo; Fiandra, C.; Franco, Pierfrancesco; Guarneri, Alessia; Ciammella, Patrizia; Stefanis, P. De; Rondi, Nadia; Moretto, Francesco; Badellino, Serena; Iftode, C.; Ragona, Riccardo; Ricardi, Umberto

doi:10.1007/s11547-012-0797-7

Cited by 14 publications

(10 citation statements)

References 26 publications

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“…Direct imaging of the prostate gland and daily verification of its position during each treatment session is essential for reducing the margins and, consequently, avoiding the organs at risk such as rectum and bladder. Several image guidance methods have been investigated in recent years, including tumor tracking with intraprostatic fiducial markers, cone‐beam computed tomography (CBCT), and ultrasound‐based imaging (US‐image guidance) 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 . Ultrasound‐based systems are volumetric and offer better soft‐tissue visualization compared to CBCT, without additional exposure to ionizing radiations (9) .…”

Section: Introductionmentioning

confidence: 99%

Impact of the observers' experience on daily prostate localization accuracy in ultrasound‐based IGRT with the Clarity platform

Fiandra

Guarneri

Muñoz

et al. 2014

J Applied Clin Med Phys

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The aim of this study is to evaluate the accuracy of daily prostate localization with ultrasound imaging of various radiation oncologists with nonhomogeneous expertise. For ten patients who underwent radical radiotherapy for localized prostate cancer, 11 radiation oncologists reviewed daily ultrasound scans acquired during three different treatment sessions. The average values of two senior radiation oncologists, considered to be expert observers, were selected as reference. The remaining nine observers were divided into two groups, Group 1 and Group 2, with more and less than one year of experience, respectively. The recorded shifts in prostate position were divided in three classes: <3 mm, 3–5 mm, and > 5 mm. Deviations from reference were less than 3 mm in all directions in 91% and 81% of measurements in Groups 1 and 2, respectively. The maximum difference in terms of root mean square error (RMSE) was reported for superior‐inferior (SI) direction, in particular a mean difference of 3.24 mm was observed for Group 2 in respect to the reference; moreover RMSE was 1 and 1.3 mm higher for Group 2 for anterior‐posterior (AP) and left‐right (LR) directions, respectively. The difference between Groups 1 and 2 was significant (p < 0.01) for all directions. The mean values for the shifts in all three directions between Group 1 and the references were 0.235 mm, 0.385 mm, and 0.009 mm for the LR, SI, and AP directions, respectively. The position of the prostate gland is more easily detectable (p.15em=.15em0.02) in the AP direction, while the visibility is lower for LR (p.15em=.15em0.02) and SI boundaries (p < 0.05). The observers' experience is essential for positioning the target correctly; therefore, a training period is recommended before putting the system into clinical practice.PACS number: 87.63.dh

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Section: Introductionmentioning

confidence: 99%

Impact of the observers' experience on daily prostate localization accuracy in ultrasound‐based IGRT with the Clarity platform

Fiandra

Guarneri

Muñoz

et al. 2014

J Applied Clin Med Phys

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“…In this context, correct and precise identification of both target volumes and critical structures are mandatory for accuracy and reliability of dose calculation (11). Several methods have been shown to provide a potential tool to deal with the issue of a poorly visualized anatomical region, with a tight dependence on the type of equipment available (12). Megavoltage CT used for planning purposes is able to consistently reduce image streaks, but requires intraprostatic fiducial marker implantation to enhance organ delineation (2).…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Ultrasound-Based Target Volume Delineation and Consequent Dose Calculation in Prostate Cancer Patients with Bilateral Hip Replacement: A Report of 4 Cases

Arcadipane

Fiandra

Franco

et al. 2015

Tumori

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Short communication needing pelvic radiotherapy such as in the case of prostate cancer (2). Prostheses should be better taken into account at the time of treatment planning and geometrically avoided during radiation delivery (3). Several different approaches have been proposed to reduce metal artifacts impact during the planning process (4). Magnetic resonance imaging (MRI) might be a potential useful tool in this context, facilitating target definition and normal structure visualization through CT-MRI coregistration (5). However, several drawbacks remain, such as different patient positioning due to diverse couching systems, eventual image distortions, and heterogeneous dose calculation due to inaccurate electron density information because of metallic implants (5). Cone-beam CT (both kilovoltage CT and megavoltage CT) is generally available in modern linear accelerators as an on-board imaging system to perform image-guided radiotherapy (IGRT) (6). Images acquired at these energies are less prone to artifacts, as the primary modality of interaction is the Compton rather than the photoelectric effect (2). The Clarity platform (Clarity System, Elekta, Stockholm, Sweden) allows for the acquisition of 3D ultrasound scans (3D-US) of the pelvic region (Fig. 1), using a 2D transabdominal probe equipped with positional sensors that needs to be swept across the patient's sovrapubic region (7). The system uses an infrared camera to

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“…Robotic arm SBRT utilizes gold fiducial makers for image guidance, which can limit its use in people who are unwilling to undergo a procedure to place the fiducials 49. Gantry SBRT can utilize severe different imaging-guidance modalities, including cone-beam computed tomography (CT),50 radiofrequency transponders (eg, Calypso ® ),51 CT on rails,52 or gold fiducial markers 49…”

Section: Theoretical Benefits Of Robotic Arm Vs Gantry Sbrtmentioning

confidence: 99%

A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

Avkshtol¹,

Lango²,

Hayes³

et al. 2016

RRU

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Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years) and acute and late toxicity (<6% grade 3–4 late toxicities). Other outcomes (eg, overall and cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.

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Tracking target position variability using intraprostatic fiducial markers and electronic portal imaging in prostate cancer radiotherapy

Cited by 14 publications

References 26 publications

Impact of the observers' experience on daily prostate localization accuracy in ultrasound‐based IGRT with the Clarity platform

Impact of the observers' experience on daily prostate localization accuracy in ultrasound‐based IGRT with the Clarity platform

Three-Dimensional Ultrasound-Based Target Volume Delineation and Consequent Dose Calculation in Prostate Cancer Patients with Bilateral Hip Replacement: A Report of 4 Cases

A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

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